前上纵隔透明血管型Castleman病误诊为胸腺瘤1例

患者女,52岁,1年前无明显诱因出现胸憋,偶有刺激性咳嗽,无发热,近20天症状加重,咳黄痰、双下肢无力。CT平扫示前上纵隔软组织肿块影,约3.8cm×2.8cm×1.8cm,边缘光滑,密度均匀,CT值约31HU(图1A),增强扫描结节明显均匀强化,值约,与邻近主动脉弓及肺动脉干分界清     

CT诊断结节/肿块型肺结核

目的探讨结节或肿块型肺结核的CT特征。方法收集接受CT检查并经病理证实的结节/肿块型肺结核患者56例,分析其病灶的CT特点。结果 56例患者中结节/肿块边缘呈分叶26例、毛刺11例、边缘光整19例;内部空洞9例、空泡6例、点状钙化9例;胸膜牵拉、凹陷征6例;支气管充气征2例,支气管狭窄、管壁增厚22例,支气管截断5例,支气管扩张2例;伴随树芽征11例,反晕征4例,淋巴结肿大10例,淋巴结钙化11例,少量胸腔积液1例。CT呈不均匀强化伴内部多发类圆形坏死区10例,均匀强化1例。结论结节/肿块型肺结核的CT征象分析有助于其诊断和鉴别诊断,对不典型肺结核的早期诊断有一定意义。     

CT诊断肾细胞癌的临床价值

目的探讨肾细胞癌的CT表现，评价CT对肾细胞癌的诊断价值。方法回顾性分析42例肾细胞癌的CT表现特征：大小、密度、边缘部特征、多期强化特点、分期、病理特点等，所有病例均行CT平扫及动态增强扫描，其中40例经手术病理证实。结果肿瘤直径小于3cm者8例，介于3-6cm者15例，6-9cm者9例，大于9cm者10例。平扫肿瘤为高密度者7例，等密度者9例，低密度者26例。24例肿瘤边缘不清，8例肿瘤边缘清晰无分叶；10例肿瘤边缘清晰有分叶。皮质期强化方式多样，皮质后期及实质期强化均减弱。本组中9例发生转移，Robson分期：Ⅰ期15例；Ⅱ期8例；Ⅲa期6例；Ⅲb期4例；Ⅲc期6例；Ⅳ期3例。结论肾细胞癌具有特征性的CT表现，CT对肾癌的诊断及术前分期具有重要意义。     

超声造影与增强CT在诊断小于3cm肾肿瘤中的对比研究

目的 对比超声造影(CEUS)与增强CT(CECT)在诊断小于3cm肾实性肿瘤的应用价值.方法 选取本院2010年1月至2013年1月期间收治的小于3cm肾占位患者54例作为研究对象,分别进行CEUS及CECT检查,观察两种方法的增强强度、增强均匀、假包膜征、增强消退时间,比较其诊断准确率,CEUS利用时间-强度曲线分析软件,对比肾脏占位性病变与病变周围正常肾组织在峰值强度、达峰时间、曲线尖度及曲线下面积的差异.结果 CEUS明显增强42例,肿瘤可见假包膜征31例,呈快进慢出39例,与CECT相比差异有统计学意义(P＜0.05),CEUS准确度92.59％,显著高于CECT(77.78％),差异有统计学意义.结论 CEUS对于小于3cm肾实性肿瘤在增强强度、增强均匀度、假包膜征、增强消退时间与CECT有不同的影像学表现,CEUS诊断小于3cm肾实性肿瘤的敏感度与准确度显著高于CECT.     

CT诊断肝结核

目的分析肝结核CT表现,以探讨其影像诊断特点。方法回顾性分析68例皆经临床诊断、术后及经皮肝穿刺病理证实的肝结核患者的CT影像学表现。结果肝结核分为三种亚型：①肝浆膜型24例,为肝包膜增厚及包膜下孤立或多发丘状低密度病灶,增强扫描环形强化、分隔样强化或无强化。②肝实质型36例,其中又分为粟粒型21例、结节型5例、肝囊肿型10例。粟粒型表现为肝实质多发、散在大小不一的粟粒或小结节灶,增强扫描无明显强化。结节型表现为肝内孤立性低密度区,病变实质无明显强化或环形边缘强化。肝囊肿型表现为大小不等囊肿样病变,圆形或不规则形,增强扫描无强化,境界清晰。③混合型8例,同时具有肝浆膜型及肝实质型表现。所有病例均合并全身多脏器结核。结论 CT表现为粟粒影、大小不等囊性灶、孤立低密度区及肝包膜下丘状低密度区,合并全身多脏器结核,特别是合并胸内结核、多浆膜腔结核时,高度提示肝结核可能。     

肝门胆管癌的MDCT诊断及其术前评价

目的 探讨MDCT在肝门胆管癌术前评估中的价值.方法 回顾经病理证实的肝门胆管癌31例,分析术前MDCT检查,观察肿瘤病灶大小、部位、强化方式、周围及远处侵犯情况、肝内胆管扩张以及肝脏、胆囊等改变,并与手术及术后病理结果对照.结果 该组中MDCT定性诊断符合率达93.5%.77.4%的病例MDCT判断梗阻部位及Bismuth-Corlette分型与手术结果相符.MDCT判断分期与临床及TNM分期总的符合率为71.0%,Ⅰ期达100%.结论 MDCT能够较好地检出肝门胆管癌和评价侵犯范围.有助于术前诊断及治疗方案的制定.     

鼻咽癌邻近结构侵犯的CT诊断

目的探讨鼻咽癌原发部位及邻近结构侵犯的CT特点。方法收集经病理证实的鼻咽癌患者42例,通过临床和CT检查,分析鼻咽癌原发部位及邻近结构受侵的规律。结果本组42例,原发灶位于鼻咽侧壁29例(69.0%),顶后壁13例(31.0%),咽旁间隙受侵34例(81.0%),颈淋巴结转移31例(73.8%),颅底骨质破坏16例(38.1%)。其中,有咽旁间隙受侵的病例中,颈淋巴结转移达82.4%(28/34),明显高于咽旁间隙未受侵的病例37.5%(3/8)(P=0.02)。有颅底骨受侵者发生头痛和颅神经症状为87.5%(14/16),明显高于颅底骨未受侵的病例19.2%(5/26)(P<0.01)。结论鼻咽侧壁是鼻咽癌好发部位,颈部淋巴结转移与咽旁间隙受侵程度有关,头痛和颅神经症状阳性是颅底骨受侵的重要指征。     

腹部局灶型Castleman病的临床特点与外科治疗

目的:总结腹部局灶型Castleman病临床表现和外科诊疗经验。方法:回顾性分析南京医科大学第一附属医院普外科2009年1月到2019年12月收治的腹部局灶型Castleman病患者的临床资料。结果:共18例患者经病理确诊而纳入。其中6例因体检而发现,12例有症状,主诉腹部隐痛不适或疼痛为50%（6/12）,头晕乏力为...     

高分辨率CT诊断胆脂瘤型慢性中耳炎

目的探讨胆脂瘤型慢性中耳炎的HRCT特征及诊断价值。方法回顾性分析45例胆脂瘤型慢性中耳炎患者的临床和HRCT检查资料，并与手术病理结果对照。结果胆脂瘤型慢性中耳炎患者HRCT表现：①45例均见中耳腔内团块状软组织影；②40例为硬化型乳突(88．9％)；③骨质改变包括中耳腔扩大和周缘骨质硬化、听小骨的移位、破坏、乳突骨质的破坏，严重者可伴有乙状窦壁、鼓室盖、面神经管及半规管的破坏。结论HRCT对大多数胆脂瘤型慢性中耳炎可作出准确的诊断，是目前该疾病的首选检查方法。     

急性阑尾炎的多层螺旋CT诊断

目的:分析急性阑尾炎的多层螺旋CT诊断价值。方法:对43例手术、病理证实为急性阑尾炎的阑尾大小、形态及盲肠周围改变等CT资料进行回顾性分析。结果:43例中有41例（95.4%）多层螺旋CT诊断正确，CT表现的直接征象为阑尾增粗增大35例（81.3%）;间接征象包括阑尾盲肠周围炎31例（72.1%），阑尾周围脓肿5例（11.6%）;有2例急性阑尾炎患者CT无明显异常。结论:MSCT阑尾扫描对急性阑尾炎的诊断有一定帮助。     

局灶性Castleman病的临床特点及治疗

目的 深化对局灶性Castleman病(localized Castleman disease,LCD)的认识,提高LCD的诊治水平.方法回顾性分析26例LCD患者的临床特征及诊疗情况,总结其临床特点及治疗策略.结果 26例患者有临床症状者10例,主要表现为以局部胀痛为主的压迫症状,3例合并副肿瘤天疱疮;孤立性淋巴结肿...     

胸部局限性Castleman病的临床特征及外科治疗

目的 探讨胸部局限性Castleman病的临床特征及外科治疗方法.方法 回顾性分析1996年6月至2008年11月收治的32例胸部局限性Castleman病患者的临床资料,探讨该病的临床和病理特点,总结其外科治疗效果.32例患者中男性14例,女性18例,年龄16～48岁,平均34.2岁.其中8例患者表现为胸闷、气短;3例患者表现为刺激性干咳;2例患者表现为胸痛;14例患者无临床症状,为体检时偶尔发现.CT检查均发现纵隔或肺门单发肿瘤.结果 除1例因术中麻醉意外死亡外,其余患者全部行手术完整切除肿瘤,病理改变符合Castleman病,病理类型以透明血管型为主.5例患者伴有副肿瘤性天疱疮,其中3例出现闭塞性细支气管炎;常规激素治疗均尤效,肿瘤切除后药物治疗1～2个月皮损明显好转,但肺部病变持续加重.术后随访全部患者均未见肿瘤复发.结论 胸部局限性Castleman病是一种罕见的胸部疾病,副肿瘤性天疱疮和肺部异常为Castleman病的少见而严重的合并症,手术切除肿瘤为首选治疗.     

超声诊断肾盂输尿管Castleman病1例

患者男,56岁,因"体检发现右肾盂占位10天"入院。查体:血压110mmHg/79 mmHg,双肾区无叩痛,无肉眼血尿等。超声:右肾集合系统分离约8.6cm×5.3cm,右侧输尿管上段管壁增厚,盂管交界部见3.3cm×0.9cm斑片状中等回声,边     

局灶性Castleman病的临床特点及治疗

Objective To improve our understanding of localized Castleman's disease ( Localized Castleman's disease, LCD) ,and to improve its diagnosis and treatment. Methods Clinical characteristics and treatment of 26 LCD cases were retrospectively analyzed, and its clinical features and treatment strategies were reviewed. Results Among the 26 cases, there were 10 cases with clinical symptoms, which mainly showed local pain induced by the compression of the tumors, and 3 in the 10 cases associated with paraneoplastic pemphigus. The swollen lymph node was at a localized area, which was mostly at retroperitoneal (10 cases) and mediastinum (7 cases). The CT scan of LCD had its special characters including local calcification and necrosis. 22 cases were of hyaline vascular type, and the other 4 cases were of plasma type based on histopathologic examination. Twenty-five patients received complete tumor resection and 2 cases of them recurred after a follow-up of 5 to 206 months averaging at 48 ± 13 months. In one case the tumor adjoining vital organs deep in the mediastinum couldn't be completely resected. This patient and another with complete tumor resection recurred and received combined chemotherapy with complete tumor disappearance and were all alive without recurrence as found by follow up to May, 2010. The other patient with recurrent tumor after tumor resection didn't receive chemotherapy and died 11 years later. Conclusions LCD patients mainly have isolated lymphadenectasis, and some patients may have systemic symptom and show abnormal laboratory results. CT scan is helpful in establishing a diagnosis of LCD.Complete surgical resection offers a favorite result for this disease.     

局灶性Castleman病的临床特点及治疗

Objective To improve our understanding of localized Castleman's disease ( Localized Castleman's disease, LCD) ,and to improve its diagnosis and treatment. Methods Clinical characteristics and treatment of 26 LCD cases were retrospectively analyzed, and its clinical features and treatment strategies were reviewed. Results Among the 26 cases, there were 10 cases with clinical symptoms, which mainly showed local pain induced by the compression of the tumors, and 3 in the 10 cases associated with paraneoplastic pemphigus. The swollen lymph node was at a localized area, which was mostly at retroperitoneal (10 cases) and mediastinum (7 cases). The CT scan of LCD had its special characters including local calcification and necrosis. 22 cases were of hyaline vascular type, and the other 4 cases were of plasma type based on histopathologic examination. Twenty-five patients received complete tumor resection and 2 cases of them recurred after a follow-up of 5 to 206 months averaging at 48 ± 13 months. In one case the tumor adjoining vital organs deep in the mediastinum couldn't be completely resected. This patient and another with complete tumor resection recurred and received combined chemotherapy with complete tumor disappearance and were all alive without recurrence as found by follow up to May, 2010. The other patient with recurrent tumor after tumor resection didn't receive chemotherapy and died 11 years later. Conclusions LCD patients mainly have isolated lymphadenectasis, and some patients may have systemic symptom and show abnormal laboratory results. CT scan is helpful in establishing a diagnosis of LCD.Complete surgical resection offers a favorite result for this disease.     

腹膜后局限性Castleman病20例临床诊治及预后分析

目的 探讨腹膜后局限性Castleman病的临床特征、诊治策略及影响预后的因素,提高伴副肿瘤性天疱疮(PNP)的Castleman病的诊治水平.方法 回顾性分析1993年1月至2009年5月在北京大学第一医院普通外科接受手术治疗的20例腹膜后Castleman病患者的临床资料,并将13例腹膜后Castleman病伴PNP患者的临床资料与同期7例单纯腹膜后Castleman病患者进行比较,分析两者在发病特点、部位、实验室检查、手术策略、病理特征及外科治疗效果的不同.结果 (1)本组腹膜后Castleman病多见于中青年(中位年龄36岁),发病部位多位于肾旁(14/20,70%)及髂窝(4/20,20%),左侧腹膜后多见,病理分型以透明血管型为主,腹膜后Castleman病合并PNP组的性别、年龄、肿瘤发病部位、大小及病理分型与单纯腹膜后Castleman病组无明显区别(P>0.05);(2)本组腹膜后Castleman病合并PNP患者较易合并闭塞性细支气管炎(8/13),有血清肿瘤标志物癌胚抗原或CA242升高现象(3/8);(3)本组腹膜后Castleman病常有包膜,与邻近脏器边界清晰,手术较为容易,但合并PNP的腹膜后Castleman病的生物学行为有恶性倾向及伴发子灶特征,有侵及邻近血管及术后局部复发可能;(4)Kaplan-Meier及Log-Rank生存分析显示,腹膜后Castleman病合并PNP患者5年生存率为42.8%,平均生存时间30个月,明显低于单纯腹膜后Castleman病组(P<0.05),是否合并闭塞性细支气管炎以及肿瘤能否根治切除是影响腹膜后Castleman病患者预后的重要因素.结论 腹膜后Castleman病伴PNP具有独特的临床特征,早期诊断和切除肿瘤、及时终止致病抗体的产生,是成功治愈的关键.     

腹部局限性Castleman病副肿瘤性天疱疮八例临床分析

目的 探讨腹部局限性Castleman病副肿瘤性天疱疮的临床表现和临床治疗方法。方法 对我院收治的8例伴有腹部局限性Castleman病的副肿瘤性天疱疮患者的临床资料进行分析,探讨该病的临床和病理特征,总结其外科治疗效果。结果 8例患者均有典型天疱疮皮肤损害,伴有难治性口唇黏膜溃疡、糜烂;病理改变表现为表皮内疱、基底细胞液化变性,表皮内散在坏死的角质形成细胞及真皮浅层以淋巴细胞浸润为主。8例患者CT检查均发现内脏单发肿瘤。5例出现阻塞性细支气管炎。所有患者常规激素治疗无效,肿瘤切除后药物治疗1～2个月皮肤及黏膜损害治愈,肺部病变缓解,切除的肿瘤位于腹膜后,病理改变符合Castleman病。结论 腹部局限性Castleman病副肿瘤性天疱疮是一罕见疾病,发现和切除合并的内脏肿瘤是治疗的关键。